By implementing CareSelect®, one site saved $250,000 over a 3-month span by avoiding unnecessary testing. Caroline Liebscher, Implementation Manager, discusses actions health systems can take now prepare for a CareSelect implementation so that your organization is set up to achieve impactful results.
Implementation Manager, NDSC
While at NDSC Caroline has been a primary manager for imaging implementations, a mentor for new team members and a people manager. She currently serves as Implementation Manager leading CareSelect Lab implementations.
Each organization we work with has their own goals and priorities for their implementation, so working to make those a reality is certainly rewarding. I think my favorite moments have been when we hear from providers that they really feel like Clinical Decision Support (CDS) will make a big impact for patient care.
Tell us more about your role at NDSC. What aspects do you enjoy the most?
I have been with NDSC for almost four and a half years now, and in that time, I have had the privilege of working on several different projects. I have been a primary project manager for imaging implementations, a mentor for new team members, a people manager, and now I also head up our CareSelect Lab implementations. There are many things I enjoy about working at NDSC, but the primary one is the feeling of accomplishment that comes from helping an organization finish an implementation. Additionally, digging into data post-live and seeing how CDS can help providers and patients is exciting.
What has been one of your team’s greatest accomplishments at NDSC?
I think every project has its own accomplishments, so it’s hard to pick just one. Each organization we work with has their own goals and priorities for their implementation, so working to make those a reality is certainly rewarding. I think my favorite moments have been when we hear from providers that they really feel like CDS will make a big impact for patient care.
Outside of imaging, our recent go-lives for CareSelect Lab, CareSelect Choosing Wisely, and CareSelect Blood have been wonderful to work on. Expanding my knowledge outside of the imaging realm has been an exciting change.
From your experience, what is most important for a customer to consider in advance of an implementation? Do you have any advice to providers help prepare for kick off?
There are many factors to a successful implementation, but one of the first that comes to mind is to come prepared with a clear definition of why you are implementing CDS, taking into consideration how CDS aligns with your organization’s mission and strategic directions. Understanding what your organization is hoping to accomplish can drive decisions we make throughout the implementation. You will have better provider adoption of the content if they understand why their use of the decision support is meaningful. It is also important to not treat CDS as a one-time project that ends at go-live, but to instead make it an ongoing operational initiative. Finally, it is essential to include clinical leaders that are passionate about the CDS solution. Their ideas and connection to the providers that will be using decision support are invaluable to the planning and execution of the implementation.
Having an idea of the project goals and who will be guiding the project are two of the key pieces for getting ready for the kick off and implementation. As part of the follow up from the kick off, the NDSC team will begin working with you on scoping decisions. Those project leaders should be involved from the beginning to make these decisions and that reason for implementing will serve as the background for many of these scoping choices.
What are some obstacles that arise during an implementation that an implementation team should be aware of in advance of a kick off? Do you have any advice to providers to prepare for such obstacles?
One of the biggest hurdles I have seen during implementations is clinician leadership engagement. The scoping, mapping, and provider testing processes rely on the expertise of the clinician leaders involved in the project. Without engaged leaders, the decision making can take longer than planned and testing may not be as thorough. We want to prepare as much as possible for the way ordering clinicians will use the system, and feedback during mapping and testing is crucial to that.
Defining who will be the clinician leaders prior to the kick off and discussing timelines early on will help ensure that project stays on track.
Can you describe an ideal implementation timeline for CareSelect Imaging to ensure PAMA compliance by the looming January 2020 deadline?
The sooner that an organization can start their implementation, the better. It’s also important to schedule your implementation ASAP since we expect demand for implementations to exceed capacity in the first half of 2019. A standard implementation typically takes three to four months to complete but can be completed in less time for some organizations. Additionally, it is ideal to have at least three months after that initial go-live to optimize a bit based on provider feedback, to complete claims testing, and to prepare your external referrers for their compliance.
How does implementation for CareSelect Lab differ?
First, is one I think everyone will be excited about — CareSelect Lab does not require a structured reason-for-exam for the decision support calculation. Instead, the CareSelect Lab content from Mayo Clinic utilizes chart data such as prior lab test results, diagnoses, etc. to determine if the selected test being ordered is appropriate or not.
Because CareSelect Lab does not require an adjustment to the provider workflow, we recommend capturing lab CDS data behind the scenes for around 90 days to evaluate the current state and determine where user interventions can provide the greatest benefit. Our goal is to provide valuable guidance to the clinicians without overwhelming them with alerts.
After Go-Live, how is CareSelect continuously optimized to meet the specific demands of each health system and ensure the most up-to-date clinical guidelines?
Once your organization is live with CareSelect, the NDSC team will work with your project team and leadership to address any content or system feedback from the ordering professionals, review usage reports, and discuss any additional communication or training that should occur. Analyzing reports of how the providers are using the content in their day-to-day practice provides insights into any additional adjustments we can make to optimize the system. This can include things like adjusting the indications that are considered common for an exam or adding additional synonyms for certain indications.
As I mentioned above, we should treat CDS as an ongoing operational initiative. In addition to the initial optimization work we will do in the first few months post-live, the NDSC Customer Success team will work with your organization to regularly review data and do content upgrades approximately once a year to ensure you stay up to date with the current recommendations from the medical societies.
With a successful implementation, how can CareSelect impact health systems in terms of waste reduction, patient care improvement and cost savings? Do you have any specific examples from a recent implementation?
We see subjective examples of savings and improvement to patient care from the implementation of decision support every day. When we look at the usage data or receive feedback from ordering providers and radiologists, we see cases where clinicians were able to order the right exam for the patient the first time, avoiding unnecessary testing. Additionally, a good objective example comes from one of our sites that calculated significant savings for the hospital (around $250,000 over a 3-month span) from avoiding unnecessary imaging.